‘It’s a medical emergency, so our response should be medical’

(Last of 2 parts)

MANILA, Philippines — Contact tracers for COVID-19 should undergo training and learn the guidelines of the Department of Health before their deployment, said Baguio City Mayor and “contact tracing czar” Benjamin Magalong.

In Valenzuela City, which Magalong has cited for best practices, the training that “normally runs from one to two days” is conducted by the city epidemiologist himself, according to Mayor Rex Gatchalian.

“The important thing here is we use doctors, nurses, or people with allied medical degrees because they are more comfortable talking about this. It’s a pandemic, it’s a medical emergency, so our response should be medical in nature also,” Gatchalian told the Inquirer.

He said people “are looking [to] the government to assist them in these trying times, so we set up a mega call center because we want people to be talking to you.”

“So before it becomes a contact tracing activity, it goes through a help desk process,” he added.

Magalong has said that Metro Manila in general was tracing only about five or six close contacts of COVID-19 patients. He said tracing 30-37 close contacts was “difficult to achieve” but that the benchmark had been set in order to “aim high.”

Thus, if the benchmark is not reached, “you are around the 1:15 or 1:20 ratio,” Magalong said.

In Valenzuela, “on the average, we do 20 contacts per individual,” Gatchalian said, adding that the city hit the 2-percent swab testing quota in July.

“Remember, the national government said at least 2 percent of your population [should be tested]. As early as mid-July, we already hit that,” he said. “That’s how aggressive we are with testing.”

‘Overwhelmed’

Interior Undersecretary Bernardo Florece said the delays in reaching out to many COVID-19 patients for contact tracing could be due to a “communication gap.”

“It may not have been reported properly, because the reports either come from the hospitals, the laboratories, or from the patient himself or his family,” Florece said. But he quickly added that these were isolated cases.

Magalong, however, argued that contact tracers were simply overwhelmed with the number of cases reported every day.

“The ideal is you have four teams for every case, you help each other.” But with the limited number of contact tracers, it becomes one contact tracing team per case, he said.

With the surge in coronavirus cases, however, one contact tracing team will have to handle five cases. “Then in the next few days, there are new cases. Then there are three more cases,” he said.

He pointed out that cases would pile up even if a contact tracing team had yet to be done with a current case.

“So gradually, the cases pile up. One way or the other, you might ignore your other cases because you are just so overwhelmed with the number of cases,” Magalong said.

“If you look at it, [an additional] 50,000 [contact tracers] is not enough. But that is only what the government can afford,” he said.

“So we need volunteers,” Magalong stressed. “That’s why part of the effort of local government units (LGUs) is to get in touch with private companies, like the manufacturing companies.”

With the help of LGUs, private companies can “train and build their own contact tracers,” he said, adding that volunteers from civic organizations could be found and trained.

He also said the fund for contact tracing was very limited because the government was supporting other COVID-19 operations.

Homegrown app

Gatchalian said Valenzuela had developed a homegrown application “that can produce maps and show us where the clusters are.”

“It can show real-time data because, remember, we have many agents encoding cases at the same time. So whenever I need data to make policy decisions, the data, the reports, are easily generated,” he said.

According to Gatchalian, the app provides real-time reports on the number of cases and of suspects and specifies where they are. “It generates maps to be able to show me if we have clusters that we have to watch, so we can do localized lockdown. It also alerts us if there are relationships among the different cases,” he said.

The application “really helps us in the governance side, in the sense that we can tailor-fit our response to what’s happening based on the data,” he said.

Gatchalian said the city government was still using “COVID Kaya,” an application that was developed and made by the World Health Organization in coordination with the Department of Information and Communications Technology.

COVID Kaya is a data collection system used by medical front-liners for submitting data on COVID-19 cases.

But Magalong said it was “very unfortunate” that COVID Kaya “does not support contact tracing because it does not record the close contacts.”

“Most of the time what are recorded are the positive cases. So it’s not a reliable source of information when it comes to close contacts,” he said.

Magalong also lamented that some LGUs still did not have a digital recording system for their COVID-19 cases. “They are still using paper. They are not using any data collection tool for their contact tracing,” he said.

He also cited some LGUs’ lack of “capacity to innovate” and to use technology.

“Despite the fact that we have given them analytical tools, some LGUs do not have the capability to immediately adapt to this technology. That’s why the progress is slow,” he said, adding that some local executives had no “active involvement” in COVID-19 activities, particularly contact tracing.

Lack of funds

One of the concerns among LGUs is the lack of funds for COVID-19, Magalong said.

Gatchalian said that, for its part, Valenzuela had realigned its disaster management funds for its COVID-19 operations. “We have also realigned funds from the general fund. We have to put on hold some of the projects in order to fund COVID-testing, tracing and isolation,” he said.

Florece told the Inquirer that LGUs could use their emergency disaster fund to give additional protection benefits to their contact tracers.

He said the DILG would recognize LGUs with exemplary performance in their COVID-19 operations. “We are collecting the best practices of the LGUs. When this pandemic is over, we are planning to give them some awards,” he said.

Part 1: Surge in COVID-19 cases overwhelms contact tracers